Herpes simplex labialis and trigeminal neuropathy

Gominak, Stasha; Cros, Didier; Paydarfar, David

doi:10.1212/wnl.40.1.151

Cited by 22 publications

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“…1,2 Only 2 of these patients had extensive sensory disturbances involving 3 divisions of the trigeminal nerve, including 1 patient with dysgeusia, similar to our case. Three of the 4 patients were female.…”

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confidence: 83%

Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

et al. 2012

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PEARLS• Herpes labialis is a common disease, but there are very few reports on herpes labialis-related trigeminal neuropathy.• Trigeminal neuropathy can be associated with frequently recurring herpes labialis, and abnormal lesions may appear concurrently in the spinal trigeminal nucleus and tract (STNT) on MRI.CASE REPORT A previously healthy 41-year-old woman with recurrent herpes labialis since her 20s noticed a herpes labialis lesion on the left side of the lower lip. After 2 days, she experienced the acute onset of tingling and a swollen sensation of the left side of the face, beginning at the V3 division of the trigeminal nerve and progressing to involve the V1 and V2 divisions over the course of 2 days. A dermatologist diagnosed herpes labialis and prescribed acyclovir 1,000 mg in 2 divided doses for 5 days. However, the symptoms did not improve after the lesion disappeared. The left side of the tongue perceived a bitter taste 8 days after the onset of symptoms. Examinations on the following day revealed decreased pinprick, temperature, and light touch sensations in the 3 divisions of the left trigeminal nerve, as well as tingling and a swollen sensation in the affected region. A swollen sensation was also present in her inner cheek. Corneal reflexes and trigeminal motor function were normal. The results of other neurologic examinations were normal. T2-weighted MRI revealed a hyperintense lesion, corresponding to the left STNT ( figure, A and B). The lesion was surrounded by edema and showed slight contrast enhancement with gadolinium ( figure, C). Examination of the CSF showed 0.7 cells/L and a protein content of 22 mg/dL; herpes simplex virus (HSV) DNA was negative on PCR.After the diagnosis of trigeminal neuropathy associated with herpes labialis and treatment with IV methylprednisolone (1,000 mg) for 3 days, the lack of facial sensation improved rapidly, but slight tingling (especially in the V3 division) and dysgeusia remained. After that, the patient's symptoms gradually resolved spontaneously and disappeared about 3 weeks after onset. T2-weighted images after resolution of all symptoms showed that the edematous lesion had disappeared, whereas the hyperintense lesion corresponding to the STNT partially remained ( figure, D).Three months later, the patient had recurrence of a herpetic lesion on the opposite side of the lower lip, but did not experience trigeminal sensory disturbance at that time.DISCUSSION In our patient, the viral reactivation at the trigeminal ganglion led to widespread facial symptoms and abnormal signal intensity on MRI, corresponding to the STNT. The STNT receives primary afferent fibers from the trigeminal, facial, glossopharyngeal, and vagus nerves. Therefore, the dysgeusia in our patient might have been caused by retrograde impulses from the inflamed STNT to the facial and glossopharyngeal nerve.Four patients with herpes labialis-related sensory disturbances have been documented previously. 1,2Only 2 of these patients had extensive sensory disturbances involving 3 divisions of...

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Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

et al. 2012

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“…Although herpes simplex virus has been implicated in many cases of presumed idiopathic Bell's palsy, in which patients typically exhibit acute peripheral facial nerve palsy, ipsilateral TNO may be seen in up to 25% of patients with Bell's palsy (6). There are only two reported cases of herpes infection-related pure trigeminal sensory neuropathy in which an intramedullary lesion was observed on MRI (3,7,8) (Table): one had extensive sensory disturbances involving the three divisions of the trigeminal nerve; the other had dysgeusia, and was similar to our case. Only our case had dissociated sensory impairment -in other words, they all had disturbances of the sensations of touch, pain and temperature, but our case is the first report of dissociated trigeminal sensory neuropathy, which was apparently caused by HSV and in which an abnormal pontine lesion was observed on MRI.…”

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confidence: 99%

Trigeminal Neuropathy Accompanied by a Pontine Lesion on MRI

et al. 2016

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A 63-year-old man presented with the loss of the sensations of pain and temperature sensation in the right facial region innervated by the trigeminal nerve (V1 to 3). He showed abnormal lesions in the pons and the trigeminal nerve on magnetic resonance imaging (MRI). He had recurrent herpes in the nasal cavity, and a history of left facial palsy. We herein present the unique MRI findings and suggest that herpes simplex infection may cause trigeminal neuropathy. This is the first reported case of dissociated trigeminal neuropathy with herpes simplex infection which was accompanied by a pontine lesion on MRI.

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“…2 E, F). C57BL\10 mice were selected for this study on the basis that, in comparison with other mouse strains, they best mimic the restrictive nature of HSV infection in humans (Gominak et al, 1990). A relatively simple, but thorough examination of virus clearance from spinal ganglia of C57BL\10 mice disclosed a strikingly rapid disappearance of antigen positive neurons over a period of 8-16 h and a transient infection of Schwann cells.…”

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Precipitous clearance of herpes simplex virus antigens from the peripheral nervous systems of experimentally infected C57BL/10 mice.

Speck

Simmons

1998

Journal of General Virology

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Clearance of herpes simplex virus (HSV) from spinal ganglia of experimentally infected mice is known to be dependent on CD8 M T-cells but not on destruction of infected neurons, consistent with a non-cytolytic Tc2 response in the peripheral nervous system. Here, we demonstrate the striking rapidity of such a response in C57BL/10 mice. The number of neurons containing viral DNA and viral antigens increased until 136 h after inoculation of virulent HSV type 1 (strain SC16) into flank skin. Subsequent disappearance of HSV DNA and antigens from infected ganglia was virtually complete only 8 h later. A consistent and unexpected observation was detection of viral antigens in sensory nerve axons for at least 8 h after their disappearance from neuronal somas, raising the intriguing possibility that virus or viral proteins may be transported distally after infection has been terminated.

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Herpes simplex labialis and trigeminal neuropathy

Abstract: Three patients had a transient trigeminal sensory disturbance associated with an ipsilateral herpes simplex (HS) labialis lesion. These cases support the theory that isolated trigeminal sensory disturbance may be caused by intermittent reactivation of HS virus in the trigeminal ganglion.

Cited by 22 publications

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Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

Pearls & Oy-sters: Trigeminal neuropathy associated with herpes labialis

Trigeminal Neuropathy Accompanied by a Pontine Lesion on MRI

Precipitous clearance of herpes simplex virus antigens from the peripheral nervous systems of experimentally infected C57BL/10 mice.

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